Objective To explore the feasibility and safety of laparoscopic directly hiatal hernia repair.Methods Retrospective analysis the clinical data of 38 patients under laparoscopic hiatal hernia repair from December 2012 to March 2015.Results 38 cases of laparoscopic hiatal hernia repair all success directly.5 routine stomach bottom part 270°fold surgery ( Toupet) 33 stomach bottom part 360°fold after operation( Nissen) operation time on average 50 to 150 minutes, the average operation time, 100 in laparoscopic hiatal hernia repair,15 to 60 ml blood loss,postoperative 24 hours to pull out the tube and liquid diet,no postoperative complications.Average hospital 7 days.Conclusion After the three months follow-up, 38 cases of patients with no recurrence of 35 cases with acid reflux,chest pain obviously improved compared with preoperative, for hiatal hernia, laparoscopic hiatal hernia repair surgery is a safe, reliable, effective treatment.

Objective To report experiences of implementing clinical pathway in hepatic cystic echinococcosis (HCE). Methods In echinococcosis appointed hospital,120 operated patients with HCR were divided into a clinical pathway group (n=60) and a control group (n=60,non-implementation of clinical pathway. Days of hospital stay including days of preoperative preparation and postoperative recovery,and hospital costs including Nation Echinococcosis Treatment Project (NETP) actual expenses,reimbursement charges,number of zero payment and patients' satisfaction index of each group were followed-up and compared. Conclusion The implementation of HCE clinical pathway can regulate patterns of diagnostic and treatment for HCE,reduce postoperative complications,shorten hospital days,reduce hospital cost,so is worthy of popularization.

目的 探讨回顾总结我院2003年-2012年10年间82例肝恶性包虫病(肝泡球蚴病)的治疗体会.方法 将本组82例按PNM分期分为早期、早-中期、中-晚期及晚期,早期(P0-1N0M0) 11例,早-中期(P1-2N0-1M0)29例,中-晚期(P2-3N1M0)26例,晚期(P3-4N1M1)16例;根据手术方案,为根治性手术(早期,早-中期)36例,姑息性手术(中期、中-晚期)28例,化疗及综合治疗(晚期)19例,并对其疗效评价进行分析.结果 (1)根治性切除病例随访3～5年,术后出现残腔积液感染2例,胆漏1例,肝功能衰竭2例,3年后复发1例,4年后远处转移2例,2例局部复发,均行化疗治愈;(2)姑息性手术治疗病例中,1年后死亡2例,两年后死亡3例,1年后局部复发3例,3年后远处转移3例,术后出现残腔感染11例,胆瘘9例,肝功能衰竭13例,均行化疗综合治疗,1年后再次行根治性手术2例,2年后再次行根治性手术1例,均恢复良好;(3)晚期病例均行化疗及综合治疗,其中4例因病灶中间液化灶较大并感染,给予手术置管引流,术后化疗2年后1例行根治性手术,5例在B超引导下PTC置管引流,术后化疗2年后1例行根治性手术.结论 对早期、早-中期病例尽可能行根治性切除术+化疗可达到治愈目的,对中-晚期及晚期病例先化疗及综合治疗,待病情稳定或病灶缩小后争取根治性手术或有条件考虑行肝移植手术较为理想,对多脏器转移者先化疗,对脏器功能影响较大的泡球蚴病先行手术治疗,再行化疗为妥.

目的：探讨基层医院实施肝囊型包虫病临床路径的可行性研究。方法针对我区包虫病定点医院包括包虫病研究所伊犁州分所（伊犁州友谊医院）和四个包虫病诊疗中心（尼勒克县医院、察布查尔县人民医院、新源县人民医院、新华医院），将我院已经实施临床路径管理的肝囊型包虫病手术患者50例设为临床路径组，未实施临床路径管理的肝囊型包虫病手术患者50例设为对照组，对两组的住院天数、手术前准备天数、手术后恢复天数、住院费用、药品费用、检查费用、药占比、检查费占住院费用比例、国家包虫病救治项目实际报销费用、国家医保报销费用、零支付人数、患者满意度指标、出院后随访率进行比较和评价。临床路径共分三篇，分别为医疗篇、护理篇、随访篇。结果与对照组比较，经数据分析的结果，平均住院天数路径组13.5 d，对照组17.5 d，P值＜0.05，有统计学意义；手术前准备天数路径组4.4 d，对照组5.4 d，P值＞0.05，无统计学意义；手术后恢复天数，路径组9 d，对照组12.1 d，P值＜0.05，有统计学意义；住院费用路径组14923.4元，对照组16447.3元，P值＜0.05，有统计学意义；药品费用路径组6941.1元，对照组8690元，P值＜0.05，有统计学意义；检查费用路径组788.8元，对照组901元，P值＞0.05，无统计学意义；药占比路径组46%，对照组50%，P值＞0.05，无统计学意义；国家救治实际报销费用路径组6612.2元，对照组7282.8元，P值＜0.05，有统计学意义；国家医保报销费用路径组8234.8元，对照组8665.2元，P值＞0.05，无统计学意义；零支付人数路径组40人，对照组27人，P值＜0.05，有统计学意义；患者满意度路径组100%，对照组90%，P值＜0.05，有统计学意义；患者出院后随访率路径组98%，对照组78%，P值＜0.05，有统计学意义。结论①在基层医院实施临床路径，可进一步规范了肝囊型包虫病诊断及治疗模式，减少手术后并发症，缩短了患者住院时间及术后恢复时间，减少了患者住院费用，减少药品费用；②通过护理篇实施护理临床路径，规范入院后的各种宣教及检查完善，通过图片宣教、哈文宣教等可使患者对健康宣教更通俗易懂、全面有效，从而提高对健康知识的掌握，提高患者满意度；③随访篇中针对出院患者，由专人负责随访及资料保管，通过临床路径随访篇的实施，可使出院后患者随访率增加，并可详细记录患者出院后服药情况、并发症及复查结果，与当地疾控中心对接，落实服药等情况，更有利于制定下一步治疗计划；④研究结果表明，在基层医院实施肝囊型包虫病临床路径是可行的。

目的：探讨我院肝囊型包虫病临床路径护理文本设计合理性及在肝囊型包虫病患者中的应用效果。方法①介绍我院肝包虫专科肝囊型包虫病临床路径护理文本的设计。②将已经实施临床路径管理的肝囊型包虫病手术患者36例设为实验组，未实施临床路径管理的肝囊型包虫病手术患者36例设为对照组。比较两组住院患者的健康知识掌握情况、住院天数、总住院费用、患者满意度、术后进食时间、出院随访情况。结果与对照组比较，实验组平均住院天数路径组13.4 d，对照组17.3 d，P值＜0.05，有统计学意义；住院费用实验组14523.4元，对照组16007.3元，P值＜0.05，有统计学意义；患者满意度实验组100%，对照组90%，P值＜0.05，有统计学意义；术后进食时间实验组为术后1.2 d，对照组为术后1.8 d，P值＜0.05，有统计学意义，出院随访情况实验组36例均无失访，对照组8例失访， P值＜0.05，有统计学意义。结论我院肝囊型包虫病临床路径护理文本设计合理有效，可缩短其平均住院时间，降低住院费用，提高患者的满意度，患者的医从性提高，失访率降低。

Objective Investigate the effects of various surgical methods for treating hepaic hydatid cases with rupture into the biliary tract.Method The patients were divided into two groups according to their conditions,such as various preoperative examinations and the situation during the operation process.The patients who underwent internal cyst extirpation+common bile duct exploration with tube drainage(68 cases)were taken as group A and those who underwent the subtotal pericystectomy+common bile duct exploration with primary suture+biliary drainage(55 cases)were taken as group B.Differences between the two groups in postoperative residual cavity complications(biliary fistula,residual cavity effusion and residual cavity infection),biliary tract complications(biliary obstruction,stenosis,infection,fistula and hemorrhage),electrolyte imbalance and average day in hospital were compared and analyzed.Results Compared with patients in group A,postoperative residual cavity complications,biliary tract complications,electrolyte imbalance and average day in hospital were improved significantly and had statistial significance(P0.05).Conclusion On the basis of correctly understanding the surgical indications,subtotal pericystectomy + common bile duct exploration with primary suture+biliary drainage can decrease postoperative complications induced by inserting T tube,shorten the hospital stay and improve the life quality of the patients after the operation.

Objective:To discuss the operative method and clinical application value of laparoscopic liver abscess drainage.Methods:Clinical data of 13 patients who underwent laparoscopic liver abscess drainage from Apr.2003 to Jun.2011 were retrospectively analyzed.Results:Twelve laparoscopic operations were successfully performed and 1 case was converted to laparotomy.2 patients underwent cholecystectomy and 1 underwent hepatic left lateral lobectomy meanwhile.Operative time was 30-120 min,intraoperative blood loss was less than 120 ml.Postoperative body temperature recovered to normal 2-4 d after operation.The drainage volume was 100-140 ml.Postoperative hospital stay was 8-21 d with a mean of 13 d.Conclusions:Laparoscopic liver abscess drainage is minimally invasive,safe and feasible,especially suitable for patients with large and multiple abscess cavity.Invalidism and physically weak patients can tolerate this procedure.This operation can decrease the hospital stay and cost,and is an ideal treatment for hepatic abscess.